The finding: In a retrospective chart review of 54 cases of “confirmed” catatonia,” patients with “suspected delirium” were found to receive a significantly more extensive (as measured by the use of 14 diagnostic tests) etiological workup.

Strength and weaknesses: This naturalistic and etiology-independent study of catatonia provides a valuable point of reference for discussion and practice comparison for consultation psychiatrists. It is noteworthy that more than half of the episodes of catatonia studies here were not of primary psychiatric etiology, and even among the >60% who received D2 blockers prior to catatonia onset, most had other etiological/predisposing factors identified. The retrospective design and vagueness about the validity of catatonia and delirium diagnoses/suspicions are major limiting factors in interpreting data. Though not a focus of the study, the fact that 83% of the 54% of patients given lorazepam “responded,” and that electroconvulsive therapy was recommended in 0%, begs the question of what became of the non-responders.

Relevance: While it does not provide guidance on what studies should be done in suspected cases of catatonia, or in what clinical contexts, with the vast majority of cases here being first-episode catatonia, this study provides a basis for practice comparison, a stimulus for prospective research, and perhaps even a starting point for developing guidelines.